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� , CHECI� OFF LIST FOR ISSUA+�'CE OF PERtinTS <br /> _ � y FOR OFFICE USE ONLY � . <br /> ADDRESS ORLEG.4L: Z.`� � �� C.:.��. ti � �� ��� O•� - <br /> PID: <br /> DESCRIPTION OF�'YORK: �'���'vy��1` /��'���i <br /> . <br /> Z01iZ\'G REVIEti�BY: � �¢ DATE APPROV�D: �3 - ' -�-�% l <br /> BUILDI�TG REVIE�BY: �' � �� DATE APPROY�D: 3 -� � �-� <br /> FEES TO BE C�L4RGED: �iisc. Fees Calculated By: <br /> pEgMiT Yes �/ No • <br /> PLAN REVIE�V Yes ✓ No SE��R CONNECTION <br /> STATE SURCHARGE Yes �'' No ti�IATII2CONNECTION <br /> IIvTVESTIGATION FEE Yes No PARK F�E <br /> SAC Yes No SITEINSPECITON <br /> Number of SAC�Unics OTHER (specify) <br /> Z0�1�G C�CK LIST zoain�Districc: N:� �-��'�%�� �� <br /> Fire Depar[ment: Post Ofuce: School District: � ' � <br /> Lot Area: Sq.fr. Acres idch Depth <br /> Surve;� Sub.�.itted: Yes No Da[e of Survey: <br /> Proposed Se!backs: <br /> Fron[ (L��Ce): Ri�h[S�de: <br /> Rear (Street): Left Side: <br /> Adjacen[Structures: �Vetl d: • <br /> guildin� Hei�`�t: Def. H�t. Pea'_; �t. <br /> Loc Covera�e: <br /> Gradin�: Stafi Approval Date: By Council Approval Date: <br /> Sepcic: Staff Approval Dace: By <br /> Zoain�File: � Resolution: � Resolution Da�e: � <br /> Shoreland District: <br /> Av�. Setback: Blufi Secback: Lot Co�'era�e: <br /> Ezistin� Proposed <br /> Hardcover: 0-7�' - <br /> 75-2�0' -- <br /> ti0-500' <br /> 500-1000' I <br /> Hardcover Varia.nce Required: Yes No� Date of Council Aoproval: <br /> REtiLA.R�iS (in house): II� <br /> 7 <br />